Healthcare Provider Details

I. General information

NPI: 1164720561
Provider Name (Legal Business Name): STEPHEN W KITT LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2011
Last Update Date: 09/15/2022
Certification Date: 09/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 RIVERWOOD CT
CONROE TX
77304-2811
US

IV. Provider business mailing address

9401 SOUTHWEST FWY
HOUSTON TX
77074-1407
US

V. Phone/Fax

Practice location:
  • Phone: 936-521-6400
  • Fax: 936-760-2898
Mailing address:
  • Phone: 713-970-7687
  • Fax: 713-970-7246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number42018
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: